PNALD is the most devastating complication of long-term PN that occurs in the majority of children receiving PN (Kumar and Teckman, 2015; Orso et al., 2016; Zambrano et al., 2004). Because its progression is typically insidious and its long-term consequences are generally underappreciated, PNALD is often recognized too late, when liver injury is irreversible. It is histologically characterized by intrahepatic cholestasis but can progress to fibrosis and cirrhotic liver failure with continued exposure to PN. There are no established ameliorative strategies for PNALD and PNALD is the leading indication for liver transplantation in infants (El Kasmi et al., 2013).